Clinician aid a form 2025

1. Click ‘Get Form’ to open the clinician aid a form in the editor.
2. Begin with Section 1, where you will enter your Patient Information. Fill in your Last Name, First Name, Gender, Date of Birth, and Ontario Health Insurance Plan (OHIP) Number. If applicable, provide proof of other publicly-funded health insurance.
3. Proceed to Section 2 for the Request for Medical Assistance in Dying. Here, you must personally complete this section unless unable to sign. Confirm your eligibility and understanding by filling in your details and signing the form.
4. If you are unable to sign, Section 3 allows an Authorized Third Person to complete it on your behalf. They will need to provide their information and signature.
5. In Section 4, two witnesses must be present upon signing. They will fill out their signatures and dates.
6. Finally, Section 5 requires both witnesses to declare their eligibility by providing their information and signatures.

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